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1. Highlights of Division Specific Accomplishments/Activities

Agency for Toxic Substances and Disease Registries (ATSDR)

A Prospective Birth Cohort Study Involving Environmental Uranium Exposure in the Navajo 

Nation, Health Investigations Branch: Extensive uranium mining and milling operations have 

occurred on the Navajo Nation during the last half century. Due to these anthropogenic 

activities, there remains a level of potential uranium exposure to the Navajo people from 

various sources including abandoned uranium mills/mines, contaminated drinking water, soil, 

and homes built with mining waste. While there have been many studies of occupational 

exposure to uranium and renal effects, there have been very limited studies on other adverse 

health effects. There is also limited toxicological and epidemiological data that indicates that 

uranium may pose a risk to the developing fetus. The purpose of this study is to quantify fetal 

risk from uranium by recruiting Navajo mothers, assessing their uranium exposure at key 

developmental milestones, and then following the children post-birth to evaluate any 

associations with birth defects in developmental delays. The study also has applied public 

health goals to provide educational outreach to increase prenatal care utilization, earlier 

assessment and referral for developmental delays, and mitigation of uranium exposure among 

Navajo mothers. In 2011, the study protocol was developed and received clearance from 

the Institutional Review Boards from all involved institutions. We have initiated clearance with 

the Office of Management and Budget and anticipate beginning study participant recruitment in 

2012. Funding-$2 million.

Petition for Health Assessment Regarding Potential Contamination from Shellfish Consumption on 

the Port Gamble S-Klallam Reservation: The Port Gamble S’Klallam tribe requested ATSDR 

Region 10’s involvement as they investigate their concerns regarding potential chemical 

exposures through shellfish consumption. After a formal consultation discussion with the Port 

Gamble S’Klallam tribe, it was agreed by all parties that a Public Health Consultation be 

conducted through ATSDR’s Cooperative Agreement Program with the Washington State 

Department of Health (WDOH). Funding in-kind.

Site Investigation at the Cyprus Tohono Mine Located on the Tohono O’Odham Nation: As part of 

ATSDR’s congressional mandate to evaluate public health impacts associated with National 

Priority Listing (NPL) sites, the US Environmental Protection Agency (EPA) designated the 

Cyprus Tohono Mine Site, located on the Tohono O’odham Nation, a Superfund Alternative 

(SA) approach site and requested ATSDR to evaluate human exposures and advise on actions 

needed to mitigate exposures, if necessary. ATSDR used the tribal consultation process to 

inform the tribe about the upcoming evaluation process and to determine who would assist with 

the evaluation. Efforts to conduct the evaluation at the Cyprus Tohono Mine Site will continue 

in FY2012. Funding in-kind.

Office of Infectious Diseases (OID): National Center for Enteric and Zoonotic 

Infectious Diseases (NCEZID)

Infectious Diseases: Published a description of the occurrence of overall and specific infectious

disease hospitalizations among the AIAN population. This analysis provides recent rates and 

identifies high-risk diseases and areas to focus further study and prevention measures for the 

reduction of infectious diseases in AI/AN communities.

Gastroenteritis: Completed analysis of the occurrence of gastroenteritis hospitalizations among 
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AI/ANs prior to and after the introduction of the rotavirus vaccine to describe the effect of the 

vaccine on hospitalizations. The findings underscored the importance of rotavirus vaccine 

among this population. 

Molluscum Contagiosum: Case control study to describe the epidemiology and risk factors that

contribute to the high incidence of molluscum contagiosum in certain AI/AN communities. 

This work will help target outreach and education activities with the long term goal of 

reducing disease incidence in these communities. 

Prion disease: Ongoing analysis of mortality data for AI/ANs with prion disease. Analyzing 

currently available data to determine the occurrence of the disease among this population in 

chronic wasting disease endemic areas.

Indian Health Service/National Death Index (IHS/NDI) Linkage Project: Committee member and 

investigator on studies analyzing deaths among overall AI/AN infants and infectious diseases 

among all AI/ANs.

Rabies: Ongoing collaborative projects with the US Department of Agriculture (USDA) and 

Navajo in AZ on dog rabies control issues. Findings increase awareness of specific infectious 

diseases. Published papers on dog rabies vaccination and bait development.

Lymphocytic choriomeningitis virus: Medical chart review of a subset of IHS patients diagnosed

with Lymphocytic choriomeningitis virus (LCMV) to verify diagnosis and estimate incidence 

of this rodent-borne disease. The medical chart review found that LCMV was diagnosed very 

rarely, and is thought to occur infrequently in AI/AN populations.

High rates of pediatric dental caries in Alaska Native children: Dental caries among Alaska Native 

children represent a substantial and long-standing health disparity. Results of an Arctic 

Investigations Program (AIP) investigation concluded that pediatric dental caries are 

approximately 5 times more common in the region than for the general US childhood 

population. The published article (CDC MMWR, Sept 23, 2011) was used to support village 

council decisions to fluoridate water supplies in 3 rural Alaska communities in Oct 2011.

Responding to pandemic H1N1 influenza in AI/AN populations: Arctic Investigations Program

(AIP) has been addressing the increased influenza mortality among AI/AN people by leading a 

5-State investigation into risk factors for deaths. We hope the results of this study will be used 

to find ways to prevent death due to influenza.

Rocky Mountain Spotted Fever: In 2011, CDC provided design input and printing of 5,000 

coloring book calendars that were distributed to children of the San Carlos and White Mountain 

Apache tribes, with a goal of educating children about RMSF. Following the distribution of 

these calendars, CDC assisted the tribes with an evaluation of the efficacy of the coloring book 

calendar campaign, by conducting a door to door survey in August 2011. CDC assisted tribes 

with the first-ever census of dogs on the reservations. The census identified that 70% of dogs 

on the reservation were free-roaming, which contributes greatly to the problem of tick 

distribution. CDC developed a pilot program for a remote dog treatment baiting system, using 

food as an attractant and treating dogs for ticks. CDC provided eight staff members who 

assisted with summer prevention efforts for both tribes, working in the field in Arizona for two 

weeks at the end of June, 2011. CDC worked with both tribes to conduct a systematic chart 

review of severe and fatal RMSF cases to identify risk factors for poor outcome; chart reviews 

were conducted throughout the year, with CDC IRB exemption and tribal approval from both 

the San Carlos and White Mountain Apache tribes. On Gila River Indian Community, CDC 

provided 4 staff members during April 2011; staff conducted a canine serosurvey to assess 
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possible spread of RMSF from an affected housing district, and to assess efficacy of prior 

year’s prevention efforts on the reservation.

Office of Surveillance, Epidemiology, and Laboratory Services (OSELS)

Epidemiologic Intelligence Officer (EIS) Officer Assignments:

 There is an EIS officer assigned to the Alaska Division of Public Health from July 2010 to 

July 2012. An Epi-Aid is in progress to assist with an investigation of what appears to be 

ongoing tuberculosis transmission in a long-term care facility in Anchorage, Alaska. The 

team is reviewing the medical records of residents residing in the neighborhood in April 

2011, reviewing records of residents in the neighborhood since January 2010 who are now 

deceased/transferred out; making recommendations on further clinical work-up of residents 

still in the neighborhood; and testing staff who have primary assignments in the 

neighborhood. The team is also doing a symptom screen and chest x-ray on all staff of 

interest and cross-checking all known people who spend time in the unit with the state's TB 

database. Funding-Direct Assistance.

 The Epidemiologic Intelligence Service (EIS) had an EIS officer assigned to the Indian 

Health Service, Division of Epidemiology and Disease Prevention located in Albuquerque, 

New Mexico during August 2010—December 2010. The EIS officer’s most notable project 

during this time was an investigation of an outbreak of severe respiratory illness among 

American Indian children in Arizona. Funding-Direct Assistance.

Public Health Prevention Service Fellow Assignments:

 A Public Health Prevention Service (PHPS) fellow assigned to the Minneapolis Department 

of Health & Family Support (MDHFS), is coordinating a project called VOICE—Valuing 

Our Individual Communities through Engagement. The goal of this project is to build upon 

and sustain engagement of cultural communities in efforts to prevent obesity and related 

chronic disease. American Indian/Native American community members have participated 

in one of the multi-cultural health story-telling sessions (similar to a focus group). FundingDirect Assistance.

 A Public Health Prevention Service (PHPS) fellow assigned to CDC’s Office of Public 

Health Preparedness and Response, Division of Strategic National Stockpile (DSNS), worked 

collaboratively with CDC colleagues and partners at NACCHO and ASTHO to develop and 

implement a special focus tribal track of the SNS summit. The goal of the special focus track 

was to share best practices in working with the tribes and tribal SNS planning. NACCHO 

provided travel scholarships for both the presenters and up to 50 tribal participants to attend

the conference. After the Summit, the PHPS fellow continued to work with the tribes to 

follow up on action items; collaborated with ASTHO and NACCHO to begin developing a 

more formal SNS tribal workgroup; and reached out to other centers within CDC who are 

working with tribes in public health preparedness and emergency response to share lessons 

learned and determine any potential collaborations that might provide better leveraging of 

resources to meet the needs of tribes, local coordinators, and state coordinators responsible 

for SNS planning. Funding-Direct Assistance.

 The Public Health Prevention Service (PHPS) had a fellow assigned to the New Mexico 

Department of Health, Public Health Division, Health Systems Bureau, Office of School and 

Adolescent Health from Oct. 2008 - Oct. 2010. In this role, the fellow worked with Native 
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American populations. The fellow’s assignment focused on adolescent health and school 

health. Specifically, the fellow led an effort to identify and understand why many schoolbased health centers (SBHC) are under-utilized, particularly by Hispanic, Native American 

and African American youth, despite the high need for services; findings are being used to 

create and disseminate youth-informed marketing materials to promote SBHC services to all 

youth. Funding-Direct Assistance.

Epidemiology Training

 Two OSELS/SEPDPO staff epidemiologists deployed with Public Health Service (PHS) 

Applied Public Health Team-4 (APHT-4) to the Pine Ridge Reservation in South Dakota

during the week of August 21–27, 2011. This was in conjunction with a clinical and public 

health training mission funded by the PHS Office of Force Readiness and Deployment. The 

SEPDPO epidemiologists worked with the Oglala Sioux Tribe and other CDC, APHT-4, and 

Indian Health Service epidemiologists to plan for an upcoming Community Health Profile 

and to conduct training on epidemiologic tools for accomplishing this activity. FundingDirect Assistance.

Office for State, Tribal, Local and Territorial Support (OSTLTS)

Public Health Law Program 

Cherokee Nation Technical Assistance: The Cherokee Nation is a sovereign people, but they do 

not live on a reservation or sovereign land protected by treaty. The Cherokee Nation public 

health staff co-exists in a working relationship with county and state public health partners. 

Originally the Cherokee Nation requested public health law technical assistance in their NPHII 

proposal to develop a public health code. However, the lack of sovereign land and the 

requirement to engage in a working relationship with county and state public health partners 

creates very complex jurisdictional issues that do not permit the Cherokee Nation to 

independently create a new public health code as described in the original request for technical 

assistance. Partnering with the American Public Health Association (APHA) the OSTLTS, 

Public Health Law Program (PHLP) engaged in a series of conference calls that included the 

CDC Associate Director for Tribal Affairs, APHA, the NPHII Senior Public Health Advisor 

and J.T. Pethrick from the Cherokee Nation. Legal research conducted by PHLP and 

discussions with tribal officials determined that Cherokee Nation does not have the exclusive 

authority to create a public health code that supersedes the authority of local and state officials. 

While the Cherokee Nation is a sovereign nation, the land they occupy is purchased, privately 

owned land located within the state and county jurisdictions. J.T. Pethrick determined that he 

needed additional time to better develop an understanding of potential strategies to work with 

local and state officials and determine whether all parties involved may be receptive to 

developing a memorandum of understanding to better identify resources and the management 

of public health issues. The current status of the issue is on hold until J.T. Pethrick can better 

formulate a formal request for technical assistance with deliverables. Currently, Cherokee 

Nation is working with local and state partners, in-house counsel and leadership to identify 

whether a specific TA request is appropriate or whether CDC can assist in the development of a 

memorandum of agreement. Funding-in kind.

Navajo Nation Technical Assistance: The Navajo Nation sought technical assistance to seek 
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PHLP input on proposed legislation to update the Navajo Nation Statutes relating to public 

health services. Specifically, the Navajo Nation Division of Public Health is seeking to pass an 

enabling statute to expand its current powers and authority to incorporate the ten essential 

services of public health, improve public health authority to oversee programs that promote 

chronic disease prevention and oversee hospital and clinical care. As part of several conference 

calls and opportunities to edit proposed legislation, the PHLP provided input to Navajo Nation 

Public Health official Anita Muneta that provides authority for a newly created Department of 

Public Health to operate under the scope of the recognized ten essential services of public 

health and further provides for the development of programs that emphasize prevention of noncommunicable diseases. Currently, PHLP staff, are awaiting final disposition of the current 

Bill by the Navajo Nation Council. If the Council passes the final Bill, PHLP will provide 

additional technical assistance to research state statutes that enable health departments that 

provide oversight to hospitals and medical clinics including authority to manage staff licensure 

requirements. These statutory examples will provide Navajo Nation, Department of Public 

Health with direction related to this aspect of the legislation. Funding-in kind.

Division of Public Health Capacity Development

Public Health Associate Program (PHAP): PHAP is a competitive, two-year, paid Centers for 

Disease Control and Prevention (CDC) fellowship. A PHAP associate is assigned to a state, 

tribal, local or territorial public health agency and works alongside local public health 

professionals. After completing the program, PHAP graduates will be qualified for future jobs 

with federal, state, tribal, local and territorial public health agencies, and will be uniquely 

prepared to pursue an advanced degree in public health. Three students are currently working 

in Indian County: Shoalwater Bay Tribal Health Department and Wellness Center in Tokeland, 

Rocky Mountain Tribal Epidemiology Center, California Tribal Epidemiology Center. 

Funding-Direct Assistance.

2. Division Specific Activities

National Agency for Occupational Safety (NIOSH)

Office of Extramural Programs

Industrial Hygiene Training: The goal of this training program 

grant is to sustain and enhance the innovative and technically strong Industrial Hygiene (IH) 

and "dual-track" Industrial Hygiene/Environmental Health Sciences (IH/EHS) programs in the 

Department of Occupational and Environmental Health (OEH) at the University of Oklahoma 

Health Sciences Center. The specific aims of the training program grant are (1) to attract highly 

qualified and motivated students, including members of under-represented minorities, into the 

industrial hygiene profession and (2) to recruit students with diverse technical backgrounds 

who are interested in entering the industrial hygiene field. The program is one of only four 

ABET-accredited masters level industrial hygiene programs in the south central United States. 

The grant will provide stipend and tuition support for full-time Master of Science students. The 

applicant pool is national in range but concentrated in Oklahoma and the surrounding region. 

The program has three core IH faculties and is supported by four other departmental faculties 

with expertise in Environmental Health, Environmental Management, and Biodefense, and by 

other faculty in the College of Public Health. The College of Public Health has long-term 
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working relationships with the Native American communities in Oklahoma, providing special 

opportunities for recruitment of students and for research. Funding-$75,000.

Division of Applied Research and Technology

Assessing the Reproductive Health of Female Workers: Infertility affects more than 2 million 

couples. Billions are spent in the U.S. annually on health care related to infertility; costs of 

reproductive dysfunction and associated health impairment permeate into the workplace. 

Three-quarters of employed women are of reproductive age; more than half of U.S. children are 

born to working mothers; 84% of working women are in jobs with likely exposure to potential 

hazards. Female reproductive dysfunction can disrupt sex hormone secretion thereby reducing 

health by increasing the rate and severity of diseases including cancers, osteoporosis, 

cardiovascular disease, psychosomatic disorders, and tissue atrophy. Reproductive dysfunction 

is a silent malady not readily detected or discussed by workers. The project will address this 

problem by developing methods to assess women’s reproductive health, incorporating these 

methods into studies to assess the reproductive toxicity of occupational exposures on women’s 

reproductive health, working with partners to provide intervention, when applicable, to 

minimize exposures and impacts, and working with colleagues worldwide to reduce the impact 

of female reproductive toxicants and hazards in the workplace. The project addresses needs of 

underserved populations: women, Native Americans, and other minorities who work in less 

desirable jobs. Funding-N/A.

Improving the Health and Safety of Minority Workers: Although the psychosocial work 

environment affects physical and mental health, little is known about how this relationship 

contributes to racial/ethnic health disparities. This project will use newly developed measures 

and methods to detect workplace risk factors salient to minority health. It will also evaluate the 

success of current workplace occupational safety and health programs and practices in 

addressing minority health needs. Data will be used to increase knowledge about the workplace 

risk factors to minority health and to generate information and resources for increasing the 

responsiveness of occupational safety and health programs and practices to the needs of 

minority workers. Resources will be disseminated to (1) community-based organizations and 

(2) work organizations that are racially and ethnically diverse. The impact of these resources 

will be evaluated. Native American Educational Services, Inc. is an external collaborator.

Funding-N/A.

Minority Health and Work Organization: Research to Practice: Although the psychosocial work 

environment affects physical and mental health, little is known about how this relationship 

contributes to racial/ethnic health disparities. A contributing factor to this state of affairs is the 

lack of appropriate measures to comprehensively investigate the contribution of the 

psychosocial work environment to problems in minority health. This project will develop and 

assess new methods to better enable the occupational safety and health research community to 

conduct targeted occupational studies on minority health or in studies of racially and ethnically 

diverse workers. This project will generate a survey instrument and a qualitative interview to be 

employed in worker studies, conference presentations, and publications. The survey instrument 

and qualitative interview are expected to be used by occupational safety and health and other 

public health researchers in various health and intervention studies. Partners including Native 

American Educational Services, Inc. have collaborated to develop the survey and interview and 

will collaborate with NIOSH to disseminate resulting information. Funding-N/A.
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OFFICE OF INFECTIOUS DISEASES (OID)

National Center for Enteric and Zoonotic Infectious Diseases (NCEZID)

NCEZID/Division of High-Consequence Pathogens and Pathology 

CDC/IHS American Indian and Alaska Native Health Analyses Collaborations: Ongoing 

epidemiologic collaborative projects with the Indian Health Service (IHS), Alaska Native 

Tribal Health Consortium (ANTHC), CDC Arctic Investigations Program (AIP), other 

agencies/divisions and universities to detect and describe disease burden and health disparities 

for overall and specific infectious diseases among American Indian and Alaska Native (AI/AN) 

communities. Studies provide information for developing prevention strategies, vaccination 

policies, and reducing health disparities related to infectious diseases. Findings increase 

awareness of specific infectious diseases, and highlight disease, person and geographic target 

areas to further investigate health disparities. For example, the identification of lower 

respiratory tract infections disparities among Alaska Native children led to more in-depth 

respiratory studies and educational efforts for children in Alaska. Funding-$140,000.

NCEZID/Division of Preparedness and Emerging Infections

Arctic Investigations Program (AIP): Arctic Investigations Program - AIP’s program mission is 

the prevention of infectious disease in people of the Arctic and subarctic, with particular 

emphasis on indigenous people’s health. AIP coordinates disease surveillance and operates one 

of only two Laboratory Response Network labs in Alaska. Highlights include: Sanitation 

services and infectious disease risk in rural Alaska: AIP assessed increased infectious disease 

risk due to lack of in-home sanitation services. The study has been used to advocate for 

increased funding for water and sanitations services in Alaska. Response to emergence of 

replacement pneumococcal disease in Alaska Native infants: AIP supported introduction of a 

new pneumococcal vaccine, PCV 13, in southwest Alaska. Usage results clarified that it 

provides protection for up to 75% of serious pneumococcal illnesses. Since routine use of this 

vaccine was begun in 2010, rates of serious pneumococcal infections have decreased in rural 

Alaska Native children. Support for Alaska Native Health Research: AIP promotes research 

activities by Tribal health organizations and supports Alaska Native/American Indian health 

researchers. Funding $3,204,301.

NCEZID/Division of Vector Born Disease (DVBD)

Prevention and Control of Rocky Mountain Spotted Fever (RMSF) on tribal lands in Arizona: 

Since 2003, Rocky Mountain spotted fever (RMSF) has emerged as a significant public health 

threat in American Indian communities in Arizona, on the White Mountain Apache, San Carlos 

Apache, and Gila River Indian Community reservations. Human infection is associated with 

transmission from Rhipicephalus sanguineus, the brown dog tick, and is supported by large 

numbers of free-roaming community dogs that provide a food source for the ticks. Through 

2011, over 200 human cases of RMSF with > 14 human deaths have been reported. The 

region’s reported incidence (527 cases per million persons) is 70X the national incidence of 

RMSF. Over 50% of deaths occur in children. The problem appears to be worsening: in 2011, 

there were 5 reported fatalities from the White River and San Carlos Apache tribes, compared 

to an average fatality of 1-2 cases per year. CDC, working together with the Arizona 

Department of Health Services and the Indian Health Service, are assisting tribes with 

developing and implementing prevention efforts to control the RMSF problem. CDC offers 

consultation, clinical evaluations of patients, educational materials, and guidance for 
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environmental control. In addition, CDC provides field staff each year to support San Carlos 

and White Mountain’s summer prevention campaigns, consisting of treating tick-infested 

homes with pesticide and placing tick collars on dogs. Funding not awarded directly to the 

tribes. Funding-$170,000 in Direct Assistance.

National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases and 

Tuberculosis Prevention (NCHHSTP)

NCHHSTP/Division of HIV/AIDS Prevention 

IHS National HIV/AIDS Program: Develop multimedia tools targeting AI/AN youth 13-21 years old 

For example: HIV prevention and sexual health promotion topics, HIV, STD and viral Hepatitis 

prevention. Funding-$1,000,000.

Capacity Building Assistance (CBA) To Improve the Delivery and Effectiveness of Human 

Immunodeficiency Virus (HIV) Prevention Services for High Risk and Racial/Ethnic Minority 

Populations: CBA is designed to assist in implementing and sustaining science-based and 

culturally proficient HIV prevention behavioral interventions and HIV prevention strategies. 

This project is funded under Category B (Strengthening community access to and utilization of 

HIV prevention services) to provide CBA to Community Planning Groups (CPGs), 

community-based organizations (CBOs), health departments (HDs) and other HIV prevention 

stakeholders. It focuses on the following goals: 1) Improve the capacity of CBOs to strengthen 

and sustain organizational infrastructures that support the delivery of effective HIV prevention 

services; 2) Improve the capacity of CBOs and HDs to implement, improve, and evaluate HIV 

prevention interventions; 3) Improve the capacity of CBOs and other stakeholders to implement 

strategies that will increase access to HIV prevention services for racial/ethnic minorities at 

high risk; and 4) Improve the capacity of CPGs and HDs to include HIV-infected and affected 

racial/ethnic minority populations and subpopulations in the community planning process, and 

increase parity, inclusion, and representation (PIR) on CPGs. Colorado State University, 

Funding-$406,125. Great Plains Chairmen’s Health Board, Funding-$369,587

Capacity Building Assistance (CBA) To Improve the Delivery and Effectiveness of Human 

Immunodeficiency Virus (HIV) Prevention Services for High Risk and Racial/Ethnic Minority 

Populations: CBA is designed to assist in implementing and sustaining science-based and 

culturally proficient HIV prevention behavioral interventions and HIV prevention strategies. 

This project provides CBA to HIV prevention planning groups, community-based 

organizations, health departments and other HIV prevention stakeholders. It focuses on the 

following goals: 1) Strengthening Organizational Infrastructure for HIV Prevention: Improve 

the capacity of CBOs to strengthen and sustain organizational infrastructures that support the 

delivery of effective HIV prevention services and interventions for high-risk racial/ethnic 

minority individuals; and 2) Strengthening Interventions for HIV Prevention: Improve the 

capacity of CBOs and Health Departments to implement, improve, and evaluate HIV 

prevention interventions for high-risk racial/ethnic minority individuals of unknown serostatus, 

including pregnant women, who are living with HIV/AIDS and their partners. The National 

Native American AIDS Prevention Center. Funding-$406,125.

HIV Prevention Projects: HIV Prevention by State and Selected City Health Departments with 

HIVP Community Planning: This project assists public health departments in their efforts to 

decrease transmission of HIV by conducting HIV prevention services for high risk persons, 

refocusing some activities to reduce the number of new HIV infections in the United States. It 
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emphasizes counseling, testing, and referral for the estimated 180,000 to 280,000 persons who 

are unaware of their HIV infection; partner notification, including partner counseling and 

referral services; and prevention services for persons living with HIV to help prevent further 

transmission once they are diagnosed with HIV. In addition, since perinatal HIV transmission 

can be prevented, CDC is strengthening efforts to promote routine, universal HIV screening as 

a part of prenatal care. All of this will be accomplished through four strategies: (1) Making 

HIV screening a routine part of medical care; (2) creating new models for diagnosing HIV 

infection, including the use of rapid testing; (3) improving and expanding prevention services 

for people living with HIV; and, (4) further decreasing perinatal HIV transmission. Funding-

$2,709,049.

Human Immunodeficiency Virus (HIV) Prevention Projects for HIV Prevention by CommunityBased Organizations: This project is funded under Category A of this program announcement to 

provide HIV prevention services for members of racial/ethnic minority communities in which 

there may be a high risk for HIV infection. Prevention services will include behavioral 

interventions [i.e., Evidence-based Behavioral Interventions (EBIs), Comprehensive Risk 

Counseling and Services (CRCS)], HIV Counseling, Testing, and Referral (CTR) Services. 

Funding for the first year also supports outcome monitoring of selected behavioral 

interventions (CBO Monitoring and Evaluation Project). Funding -$306,886.

NCHHSTP/Division of STD Prevention

STD Prevention, Screening and Treatment: STD Prevention, screening and treatment services in 

Indian Country. Funding -$232.052.

Support for Public Health Advisor: Salary and benefits for Public Health Advisor. Funding-

$120,824 in Direct Assistance.

Indian Health Service, Division of Epidemiology and Disease Prevention Medical EpidemiologistSalary Support in Indian County: Staff support for Medical Epidemiologist, Indian Health 

Service Division of Epidemiology and Disease Prevention; stationed in Phoenix, AZ. Funding-

$191,717 in Direct Assistance.

Partial Staff Support for Public Health Advisor in Indian Country: Partial support for Public 

Health Advisor, Indian Health Service, Division of Epidemiology and Disease Prevention; 

located in Albuquerque, New Mexico. Funding-$40,390 in Direct Assistance. 

NCHHSTP/Division of Tuberculosis Prevention

Epi-Aid 2011-67, “Investigation of Increased Number of Tuberculosis Cases Among American 

Indians, Navajo Nation Reservation, Arizona and New Mexico, USA,” July 5-22, 2011: 

Surveillance, Epidemiology, and Outbreak Investigations Branch (SEOIB) provided 

supervision, with staff from International Research and Programs Branch (IRPB), Field 

Services & Evaluation Branch (FSEB), and also from DSTDP on the ground. During 2010–

2011, the Navajo Nation Division of Health (NDOH) identified an increase in the number of 

tuberculosis (TB) cases among residents of the Navajo Nation reservation, which spans a large 

region primarily in Arizona and New Mexico. On May 27, 2011, the NDOH and Arizona 

Department of Health Services (AZDHS) notified CDC of a TB outbreak associated with a 

hospital serving the Tuba City Indian Health Service (IHS) service unit. This service unit 

provides clinical and public health services to Native persons (primarily Navajo and Hopi) in 

the northwestern area of Arizona. AZDHS and partners assisted the NDOH TB Control 

Program in the initial outbreak investigation. Subsequently, on June 16, NDOH and AZDHS 

informed CDC of a second outbreak of seven TB cases diagnosed over <12 months in a 
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community in the Fort Defiance IHS service unit, located in eastern Arizona and primarily 

serving a Navajo population. Epi-Aid Overall Objectives: 1) Describe the current epidemiology 

of TB on the Navajo Nation reservation, 2) Identify chains and recent transmission within TB 

clusters on the reservation, 3) Identify and prioritize contacts of infectious TB cases for 

evaluation and treatment and 4) Provide recommendations to interrupt further transmission of 

TB. Funding-no specific award for this activity.

Office of Non-communicable Diseases, Injury and Environmental Health 

(ONDIEH)

Agency for Toxic Substances and Disease Registries (ATSDR)

Lummi Indian Seafood Consumption Survey Project: The Lummi Indian Nation is working to 

establish tribe-specific fish consumption rates in order to develop appropriate risk assessments 

which will aid in cleaning up contaminated sites, improving habitat conditions, and improving 

water quality standards on tribal lands. Funded - $75, 000

National Center for Environmental Health (NCEH) Activities

NCEH/Division of Laboratory Sciences (DLS)

Nicotine Exposure and Metabolism in Alaska Native Adults Research Study: The Division of 

Laboratory Sciences (DLS) Emergency Response and Air Toxicants Branch provided in-kind 

laboratory analysis via agreement with the Alaska Native Medical Center (ANMC) /Indian 

Health Service (IHS) on a cross-sectional study of 400 Alaska Native (AN) adult tobacco users, 

50 male & female smokers, commercial chew users, iq’mik users and non-tobacco users who 

received medical services in Dillingham, Alaska. The objective of the study was to generate 

information on nicotine & carcinogen exposure in underserved Alaska Natives. DLS completed 

chemical analysis of Alaskan iq’mik, a native smokeless tobacco mixture that combines 

tobacco and fungus/plant ash, and performed measurements in urine for cotinine (a nicotine 

byproduct). Funding in-kind.

National Center on Birth Defects and Developmental Disabilities (NCBDDD)

NCBDDD/Division of Human Development and Disability

Project CHOICES Pilot Implementation and Evaluation for American Indian and Alaska Native 

(AI/AN) Women: Fetal Alcohol Syndrome (FAS) and other prenatal alcohol-related conditions 

are highest among American Indian and Alaska Native (AI/AN) populations (2.5 to 5.6 per 

1,000 population) according to published reports. CDC’s CHOICES project is an effective 

behavioral approach for preventing alcohol-exposed pregnancy (AEP), targeting both alcohol 

use and effective contraception. In 2010, CDC and Indian Health Service (IHS) entered into a 

3-year interagency agreement to adapt and implement CHOICES in American Indian 

communities. This project will reach out to American Indian women of reproductive age of the 

Oglala Sioux Tribe in South Dakota. In October 2011, implementation of the intervention 

began in three clinics (Native Women’s Health Center in Rapid City – Oglala Sioux tribe 

clinic, and IHS clinics in both Kyle and Wanblee on the Pine Ridge reservation). Feasibility 

and acceptability of the intervention by American Indian women will be evaluated. Funding-

$150,000.
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National Center for Chronic Disease Prevention and Health Promotion

(NCCDPHP)

NCCDPHP/ Division of Community Health-Proposed

Strategic Alliance for Health: The intervention area includes the Tribal Jurisdictional Service 

Area (TJSA) of 9,200 sq. miles with a population of 399,385 in 14 counties. The Cherokee 

Nation has developed, implemented, and expanded a comprehensive plan to implement 

promising strategies for healthy eating, active living, and tobacco-free environments in the 

Cherokee Nation of Oklahoma -- the Eastern band of the Cherokee Nation. Their interventions 

are guided by the research, collaboration, and recommendations of the public health experts 

and stakeholders via the Healthy Eating Active Living Convergence Partnership. Funding-

$400,000.

Preventive Health and Health Services Block Grant: The funds are used to compliment existing 

funds to support the tribal EMS system. Data development and training are two areas of need.

Funding- $22,083. Funds a Boys/Girls Club Youth Leadership Initiative which entails 

attendance at a National Youth Leadership Conference and local activities. Funding- $22,083

Seeds of Hope: Seeds of HOPE (SOH) focuses on dissemination and implementation of HOPE 

Works (our previous project) via community-based organizations. SOH is adapted based on 

findings and lessons learned from HOPE Works project. Effectiveness of the disseminated 

program will be evaluated using a randomized experimental design. One study arm will 

implement the SOH model that includes HOPE Circles, tailored newsletters, and activities to 

support education and empowerment including financial literacy. The other arm, Seeds of 

Health, will receive education on other health topics via email newsletters and group learning 

sessions for twelve months. Materials and methods will be adapted and targeted for 

dissemination via community organization partners including churches, tribal centers, and other 

community groups. Funding-$316,000.

Healthy Native North Carolinians: Continuing the momentum of the American Indian Healthy 

Eating research project, the North Carolina Commission of Indian Affairs (“Commission”) 

aims to reduce the high prevalence of childhood obesity amongst American Indian children by 

focusing on children ages 3 to 18 and the broader communities in which these children and 

adolescents live, pray, study, eat, and play. Specifically, the Commission will partner with 

participating tribes and urban Indian organizations in North Carolina on Healthy, Native North 

Carolinians. This new initiative strives to increase the likelihood that participating tribes and 

urban Indian organizations can be more effective in creating measurable and meaningful 

community changes to promote healthy eating and active living. Throughout this initiative, 

efforts will be made to integrate and facilitate community and state-level partnerships with 

tribal youth groups, faith-based organizations, healthcare systems, economic development, state 

health agencies, and corporations. The Commission, along with participating tribes and urban 

Indian organizations will partner with a workshop development and evaluation assistance team 

at the University of North Carolina-Chapel Hill. The goal of this two-year community change 

capacity building workshop series is to facilitate capacity for developing, implementing, and 

evaluating community changes around healthy eating and active living within participating 

tribal communities and to help leverage common goals and resources amongst participating 

tribal communities. Funding-$246,708.

SIP 10-033: Innovative Approaches to Preventing Teen Pregnancy among Underserved 
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Populations: The goal of this 4 year Special Interest Project (SIP) is to adapt and evaluate the 

effectiveness of an Internet-based HIV/STI, and pregnancy prevention curriculum for 

American Indian/Alaska Native (AI/AN) middle school-aged youth (12-14 years). This 

curriculum will be adapted from a successful, Internet-accessible, prevention program, It’s 

Your Game...Keep it Real, (IYG). To capture the heterogeneous experience of AI/AN youth 

the AI/AN-IYG Internet-based program will be adapted and evaluated in 3 large, 

geographically dispersed AI/AN communities in Alaska, the Pacific Northwest (Oregon, 

Washington State, Idaho), and Arizona Plains. Funding-$350,000.

NCCDPHP/Division for Adolescent and School Health.

Students for Success: Promote coordinated school health policies, programs, and practices with 

an emphasis on physical activity, nutrition, and tobacco-use prevention. They provide

technical assistance to four partner schools to support the planning and implementation of 

school health council meetings. Provide professional development and technical assistance to 

school personnel on curriculum, policy, social marketing, and other activities to support 

building a healthy nutrition environment. Provides professional development and technical 

assistance to school personnel on curriculum, policy, social marketing, and other activities to 

support building a tobacco-free environment for all students, staff, and visitors. Provides 

technical assistance to four partner schools to support the planning and implementation of 

school health council meetings. Uses CDC’s Health Education Curriculum Assessment Tool to 

identify health education curricula that meets national standards and best practices. Offers 

professional development and follow-up technical assistance opportunities to teachers and 

curriculum directors on Health Education Standards. Encourages site coordinators to attend 

national training to improve their capacity and skills in providing technical assistance to local 

school districts and buildings. Uses CDC’s Health Education Curriculum Assessment Tool to 

identify health education curricula that meets national standards and best practices. Conducts 

CDC's Youth Risk Behavior Survey without being funded to do so. Funding-$275,097.

Coordinated School Health: The Maine Department of Education is funded for HIV Prevention, 

Coordinated School Health (CSH)/Physical Activity, Nutrition, and Tobacco, and the 

YRBS. Maine’s three tribal schools were selected in a competitive process to participate as 

priority schools in the state’s coordinated school health program. All tribal schools participated 

in professional development tailored to their needs, mini-grants of $5,000 per school per year), 

and on-going technical assistance. All tribal schools completed CDC’s School Health Index 

(SHI) and used the results to revise and improve their wellness policies. Every tribal school 

implemented new healthy eating and/or physical activity promotion initiatives. Highlights 

include: new physical activity breaks during the academic day policies, recess before lunch 

policies, and inclusion of students in school menu choice, before school walking clubs and 

establishing school gardens and healthy cooking clubs. In addition, the Maine Indian Unified

School Committee augmented their tobacco policy passed last year with implementation of an 

alternative to suspension tobacco cessation program. The tribal schools represent a small 

portion of students served with Maine's CSH program. Funding-$369,557.

Cherokee Nation YRBS and School Health Profiles: The Cherokee Nation receives funding to 

conduct the Youth Risk Behavior Survey (YRBS). The goal of this program is to advance the 

knowledge of critical health related behaviors among high school students through data 

collection and dissemination. With technical assistance from CDC/DASH, in 2011, Cherokee 

Nation administered the YRBS in high schools within the Tribal Jurisdictional Service Area to 
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obtain data representative of students in grades 9-12. To plan, promote, and disseminate results 

from the YRBS, the Cherokee Nation also collaborated with multiple community partners. The 

Cherokee Nation also started to prepare sampling frames to conduct the 2012 School Health 

Profiles. Funding-$10,000.

Bureau of Indian Education (BIE) and Navajo YRBS and BIE School Health Profiles

CDC/School Health provides technical assistance to the BIE and Navajo Nation to conduct the 

YRBS. Both the BIE and Navajo YRBS are conducted every 3 years. BIE administers the 

YRBS to middle and high school students attending Bureau-funded schools across the United 

States. The Navajo Nation, working with the Indian Health Service, conducts the YRBS 

among middle school and high school students attending public and private schools on the 

Navajo Reservation and in a small number of “bordertown” schools with high Navajo student 

enrollment. This surveillance activity is designed to determine the prevalence of health-risk 

behaviors among students, assess trends in these behaviors, and examine the co-occurrence of 

health-risk behaviors. The YRBS collects data on health risk behaviors among young people 

so that health, education, and tribal agencies can more effectively target and improve 

programs. Both BIE and the Navajo Nation most recently conducted the YRBS in the fall 

2011. Data will be processed in spring 2012 at which time CDC/DASH will provide technical 

assistance to BIE and the Navajo Nation to help generate YRBS reports. During 2011, 

CDC/DASH provided technical assistance to the BIE to conduct the School Health Profiles 

survey to obtain representative information about current school health policies and practices 

within BIE-funded schools. BIE will administer the School Health Profiles survey in spring 

2012. Funding-in kind.

Winnebago Tribe Youth Risk Behavior Survey (YRBS): The Winnebago Tribe of Nebraska 

receives funding to conduct the Youth Risk Behavior Survey (YRBS). The goal of this 

program is to advance the knowledge of critical health related behaviors among middle and

high school students through data collection and dissemination. The Winnebago Tribe obtained 

weighted data (allowing for generalized results) in 2011 for both their middle school and high 

school YRBS. Funding-$10,000.

NCCDPHP/Division of Cancer Control and Prevention

Colorectal Cancer Control Program Division of Cancer Control and Prevention (DCPC) 

The CRCCP's goal is to increase colorectal (colon) cancer screening rates among men and 

women aged 50 years and older from about 64% to 80% in the funded states by 2014. The 

program provides population-based approaches to increase colorectal cancer screening rates 

among the U.S. population 50 years of age and older that can lead to health systems change, 

outreach, case management and limited provision of direct screening services. Funded 

Programs include: Arctic Slope Native Association, Funding-$385,878, Alaska Native Tribal 

Health Consortium, Funding-$750,000, South Puget Intertribal Planning Agency, Funding-

$650,000 and South Central Foundation. Funding-$740,000.

EARLY ACT AIAN Project - "Walking Together: Making A Path Toward Healing: The purpose 

of this Intra-Agency Agreement (IAA) is to support the Phoenix Indian Medical Center (PIMC) 

Oncology Program to identify and describe the impediments to care physically, psychologically 

and spiritually faced by young AI/AN women diagnosed with breast cancer under the age of 45 

from their own viewpoint. Through focus groups, the patients understanding of the barriers 

they faced in getting care for their breast cancer as well as their viewpoints regarding services 

available or unavailable to them will be studied. The information gathered will be used to 
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develop recommendations for targeted interventions that will address common concerns in 

these patients breast cancer journey. Funding-$112,347.

Enhancing Cancer Prevention and Control Programs for American Indian/Alaskan Native Women

1) As part of Native American Cancer Research Corporation's (NACR) ongoing CDC grant, 

NACR is coordinating 2 Regional meetings each grant year. NACR will be implementing and 

evaluating 10 Regional Planning Conferences / working meetings in collaboration with local 

public health professionals and organizations that actively work with American Indian or 

Alaska Native (AI/AN) organizations and communities. 2) NACR will address gaps in AIAN 

cultural awareness materials (including designing, developing, and distributing AI/AN cultural 

appropriate public education and awareness materials. This includes one Native Wellness 

booklet annually and one case study annually. 3) NACR will provide technical assistance 

related to cultural appropriateness and awareness, as approved by the CDC, to states' Indian 

Health Service, tribal and urban programs and others, on an as needed basis. 4) Lastly, NACR 

will implement and evaluate cultural awareness trainings. Funding-$400,000.

Tribal BRFSS Project:The purpose of this Intra-Agency Agreement (IAA) is to support the 

Tribal BRFSS Project at Northwest Portland Area Indian Health Board. The objective of this 

project is to provide Tribal grantees of the National Comprehensive Cancer Control Program 

with accurate health behavior data that is not readily available through the state BRFSS for 

Tribal communities so that programs can use these data to assess cancer risk factors for their 

population and monitor progress toward reaching cancer plan objectives. Northwest Portland 

Area Indian Health Board will be subcontracting with Intertribal Council of Arizona to support 

a Tribal BRFSS Project with the Tohono O’odham Nation. Funding-$280,000.

National Breast and Cervical Cancer Early Detection Program: Early Detection Program provides 

access to breast and cervical cancer screening services to underserved women. Programs 

funded include: Arctic Slope Native Association Funding-$561,519, Cherokee Nation Health 

Service Group Funding-$846,660, Cheyenne River Sioux Tribe Funding-$409,708, Hopi Tribe 

Funding-$516,917, Kaw Natin of Oklahoma, Funding-$369,358, Native American 

Rehabilitation Association, Funding-$488,163, Navajo Nation, Funding-$871,458, Poarch 

Band of Creek Indians, Funding-$86,150, South Puget Intertribal Planning Agency, Funding-

$508,752, Southcentral Foundation, Funding-$1,339,709, Southeast Alaska Regional Health 

Consortium, Funding-$670,000 and Yukon-Kuskokwim Health Corporation, Funding-

$615,000.

National Comprehensive Cancer Control Program

Comprehensive Cancer Control (CCC) is a cost effective approach that brings key stakeholders 

together to develop and implement population-based public health approaches to reduce the 

burden of cancer. Grantees are funded to develop and implement policy-related, systems-level 

or environmental changes aimed at preventing cancer, detecting cancers early when they are 

more treatable, increasing access to treatment, and improving the quality of life of cancer 

survivors.

The Northern Plains Comprehensive Cancer Control Program (NPCCCP) was 

established in July 2005. NPCCCP is in the fourth year of a five year implementation

funding opportunity. NPCCCP has initiated, facilitated, and assisted in several projects 

throughout the last project period. We have leveraged numerous partnerships on the local and 

state level, regionally, and nationally and work continuously to foster these partnerships while 

identifying new ones at every organizational level. In the following narrative we have 
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identified several projects, activities, and accomplishments that have contributed to the 

success of our program. Participation includes representation from all Tribal Health/Indian 

Health Service (IHS) programs in the region, all four state departments of health (IA, NE, SD, 

ND), and many AI cancer organizations, cancer centers, and universities. The coalition has 

grown to 266 registered members, many of whom are active in workgroups, community event 

participation, and cancer survivorship activities. Within our coalition, we have a steering 

committee that, in addition to providing guidance, has been instrumental in the development 

of the NPCCCP Cancer Plan. We are currently in the planning stages for the revision of the 

cancer plan and anticipate the second NPCCCP cancer plan to be completed in early 2012. 

Data/Surveillance- NPCCCP works very closely with the Northern Plains Tribal Cancer Data 

Improvement Initiative and assists in conducting data collection, analysis, and surveillance 

activities. A manuscript on cancer risk and screening use based on Behavioral Risk Factor 

Surveillance System data was accepted by the Public Health Report journal for publication in 

April 2011.

Fond du Lac. With the support of Fond du Lac (FDL), Wiidookaage Cancer Team members, 

FDL HSD staff, FDL Tribal Leadership, FDL community members and several external 

cancer partners continued to expand implementation of the Fond du Lac Band of Lake

Superior Chippewa Wiidookaage Cancer Plan 2007 -2012. Maintained contact and mutually 

beneficial interaction with the 39 cancer partners from tribal, local, state and national cancer 

related agencies. Piloted the National American Cancer Society's revised “Circle of Life” 

program during fall 2010. The revisions were based, in part, on Fond du Lac's model, “Circle 

of Life Plus” adding all screenable cancers, supportive resources information and cancer 

prevention information to the previously breast and cervical cancer focused program. The new 

“Circle of Life” will be introduced nation-wide in 2011 to interested tribal programs.

Funding$-261,346. 

Other funded projects include: Alaska Native Health Consortium Funding-$326,132, 

Cherokee Nation Health Service Group Funding-$379,019, Northwest Portland Area Indian 

Health Board Funding-$300,000, South Puget Intertribal Planning Agency Funding-$275,000

and Tohono O’odham Nation Funding-$177,575.

NCCDPHP/Division for Diabetes Translation

Aleut Diet Program: The Aleut Diet Program includes sustainable hands on activities focusing 

on the healthy preparation and utilization of local traditional foods. The purpose of these 

activities is to promote health and prevent type 2 diabetes in the Aleutian and Pribilof Islands 

Region of Alaska. The program focus is to improve the nutritional health of people in the 

region through increased awareness of the benefits of traditional foods and the important role 

these foods play in reducing rates of dietary-related diseases such as diabetes, obesity, cancer, 

heart disease, hypertension, and dental caries. The program also seeks to encourage increased 

consumption of traditional foods from the land and sea by all members of the community as 

part of a healthy diet. The activities of the program are centered on culturally relevant 

information dissemination and the development of written resources that speak to the 

nutritional benefits of traditional foods. Funding-$100,000.

Catawba Lifestyle and Gardening Project: The Catawba Cultural Preservation Project (CCPP) in 

South Carolina is increasing awareness and the use of traditional foods and food practices by 

supporting individual and community gardens, and increasing fruits, vegetables, beans, and 

herbs in tribal members’ diets by providing access to local gardens and a tribal farmer’s market. 
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The tribe is adopting policies that include preferred ecological methods for gardens using 

traditional growing methods to encourage a new generation of environmental stewards to care 

for the reservation ecosystem. The tribe is increasing physical activity with gardening, fishing, 

and traditional dancing and drumming. Innovative partnerships between the tribal Senior 

Center, CCPP, the Catawba Tribal Offices, and a Master Gardener have yielded a successful 

community garden project that is increasing local access to fresh, locally grown, and in some 

cases traditional foods. Elevated box gardens have been constructed for the senior center that 

mitigates the effects of aging on being able to fully participate in gardening. Additionally, 

changes in local practice within the Children’s Programs are becoming a precursor to policy 

change. Emphasis is on elimination of sugar-sweetened beverages, incorporation of fresh, 

locally-grown produce into lunch menus, and healthy snack alternatives are the focus of 

changes enacted thus far. Funding-$100,000.

Cherokee Nation - Health Nation: The “Cherokee Nation – Health Nation” project incorporate a 

variety of activities including community and school gardens, traditional foods gathering trips, 

traditional Cherokee foods cultivation, gathering, preparation, and preservation, traditional 

Cherokee foods education, and incorporation of the traditional Cherokee games Stickball and 

marbles into community and school activities. Over 55,000 members of the Cherokee Nation 

and their families benefited from the initiative’s focus on nutrition, fitness, personal 

responsibility and a renewed awareness of their shared heritage. Youth activities focused on 

summer camp activities, organized sports and traditional games. Adult fitness activities were 

year round and centered on recreation center classes, league sports walking clubs and 

community races. Traditional games such as stickball and marble saw an exponential increase 

from the year before. Nutrition classes, healthy cooking classes, community garden classes and 

recipe exchanges (all with a focus on traditional Cherokee foods) were offered in all fourteen of 

the counties within the Cherokee Nation jurisdiction. Funding-$100,000.

Healthy Roots for Health Futures: Healthy Roots for Healthy Futures works to increase 

the availability and accessibility to healthy, local, traditional foods and traditional forms of 

physical activity. The availability and access to local, traditional, healthy foods have been 

increased through the creation of entrepreneurial training and gardening programs, revision of 

the School Wellness policies, and development of a Farm to School system. Physical activity is 

promoted through gardening and trail use. Revitalization of trails reconnects communities to 

the traditional paths of their ancestors, while increasing options for physical activity. Funding-

$100,000.

Indian Health Care Resource Center of Tulsa: Strengthening Traditional Ties: The program 

encourages American Indian families to eat nutritious diets and adopt healthy active lifestyles. 

Families participate in school-based health, nutrition, and physical education programs, 

including summertime wellness camps and a theatrical production. The program also engages 

in educational programs that emphasize healthy lifestyle choices within the context of 

traditional cultural practices, such as expanding existing and creating new neighborhood and 

school-based gardening projects. "Building Community" established gardening partnerships 

with two local elementary schools, summer camp programs featuring the Coordinated 

Approach To Child Health curriculum, and worked with state-level leaders on healthy food 

initiatives to address the problem of food deserts. Funding-$100,000.

Listen to the Elders Project: Nooksack Indian Tribe, Listen to the Elder’s Project involves 
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gardening and planting activities, distributing garden related materials, increasing community 

knowledge, awareness and use of traditional foods, and increasing physical activities, such 

canoeing and hunting. Funding-$100,000.

Return to a Healthy Past: Return to a Healthy Past” (RTHP) has reintroduced traditional foods 

and physical activities in the Prairie Band of Potawatomi Nation (PBP) to promote health and 

prevent diabetes among other chronic conditions. Serving as a model, for rural and urban 

communities, RTHP has established gardens, increasing production and access to traditional 

produce. Through partnerships with the Land Department, Tribal Council, local hunters and the 

Diabetes Prevention Program, a wider variety of indigenous produce and meats were offered in 

diabetes education courses, Elders’ Center and Language Department gatherings and the Fall 

Harvest Feast. Traditional forms of physical activity have been broadened through nature hikes, 

camping trips, and gardening activities. RTHP continues to engage tribal members of all ages, 

at risk for or living with diabetes. Community members have increased access to traditional 

and other physical activities due to their exposure to this project’s activities such as hiking to 

identify wild plants and traditional foods such as wild onions, milk weeds and individual/family 

gardens. Funding-$100,000.

Empowering Ramah Navajos to Eat Healthy (ERNEH) This Project provides materials, training 

and technical assistance to families to help them grow fresh vegetables in their own yards by 

using conventional in-ground gardens, developing raised bed gardens, or planting in 

commercially-viable garden boxes. The Project also encourages physical activity and works to 

improve access to a greater variety of physical activities through community support. The 

Project also provides technical assistance and training regarding food use, preservation, and 

assistance in selling excess produce. Finally, the book, "Traditional Navajo Foods & Cooking", 

will be updated, first published by the Ramah Navajo School Board in 1983. Forty-five 

community members participating in the gardening project have increased access to healthy 

traditional food fully as a result of the efforts of the ERNEH Project; another fifty-nine have 

increased access partially as a result of project efforts. Sixty-seven Honor Walk participants 

have increased access to information about traditional food fully as a result of the ERNEH 

Project. Funding-$100,000.

Old Ways for Today's Health: Red Lake Traditional Foods Project: Red Lake Nation’s Old Ways 

for Today’s Health: Red Lake Traditional Foods Project works to reinstate the consumption of 

a traditional healthy diet at the Red Lake Nation utilizing family and community gardens, 

traditional food gathering encampments such as fishing, berry picking, hunting, wild ricing and 

maple sugar gathering and cooking camps. The project will collaborate with partners, including 

the tribal diabetes programs, Chemical Health, and community center boards to provide 

community education through media, demonstrations and community participation. Through 

the traditional foods gathering activities, Red Lake Nation members have an increased 

opportunity to be physically active. The level of physical activity is dependent on the type of 

activities associated with gathering these foods. Deer hunting and buffalo canning has the 

lowest level of exertion of energy while berry picking and sugar bushing require a high level of 

physical energy for an extended period of time. With a total of 120 participants in activities 

during the first six months of Year Two, there has clearly been an increase in community 

members being physically active. Funding-$100,000.

Traditional Living Challenge in Contemporary Times: Indigenous Knowledge for Community 

Wellness: Salish Kootenai College (SKC) is building on programming that focuses on physical 
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activity in relation to traditional foods gathering efforts. The overall project activities are 

blending the ancestral wisdom of traditional foods and lifestyles with contemporary realities. 

Two major components regarding traditional foods will be utilized to support active healthy 

lifestyles and physical activities based on traditional activities with a focus on youth: first, 

activities surrounding the permaculture of indigenous plants, and second, continuation of the 

Ancestors’ Choice social marketing campaign to promote a healthy diet and lifestyle for the 

prevention of type 2 diabetes. Funding-$100,000.

Wiconi Unki Tawapi - Healing Our Live: The program focuses on educating tribal members on 

the importance of traditional healthy foods and physical activity/exercise by the use of 

traditional techniques and teaching traditional practices. This will be accomplished through a 

variety of activities such as: gardening, canning and pressure-cooking classes, diabetes classes, 

diabetes awareness activities (booths, health fairs), weight loss classes, and the Young Braves 

Program. Funding-$100,000.

Uniting to Create Traditional and Healthy Environments: Sault Ste. Marie (SSM) Tribe of 

Chippewa Indians, “Uniting to Create Traditional and Healthy Environments”. Project serves 

seven county service units. Partnership and collaborations with other Tribal programs and 

surrounding health services help the Project organize, support and serve SSM Tribal members. 

The Project has created a Healthy Traditions Advisory Council (HTAC), which will help the 

Project to carry out Traditional Foods, Social Support and Physical Activities and/or events, 

such as berry picking camp, workshops, training master preservers, implementing garden 

projects, building a Hoop House, implementing the harvest feast celebration, involvement in 

the local farmer’s market, implement fitness promotion, healthier food fundraising event, and 

digital storytelling. Funding-$100,000.

WISEFAMILIES through Customary and Traditional Living: WISEFamilies Traditional Foods 

program supports community driven programs that helps people adopt healthy lifestyles. The 

program builds on traditional ways of eating, being active and communicating by storytelling. 

All activities are developed with the goal to prevent chronic illness. Prior to the CDC 

Traditional Knowledge program, tribal members have expressed concern that the “old ways” of 

gathering and preparing traditional foods were being lost. The Wrangell program has impacted 

85% of Alaska Native families in the community and the media exposure has included near 

weekly newspaper articles and numerous stories on the local radio station. Members of the 

Local Community Advisory Board have commented on how instrumental this program has 

been for invigorating the community’s awareness of traditional foods and the importance it 

plays in health and culture. Funding-$100,000.

Siletz Healthy Traditions Project: The Confederated Tribes of Siletz Indians' (CTSI) “Siletz 

Healthy Traditional Project” promotes health and prevention of diabetes through traditional 

foods and sustainable ecological approaches in the Siletz Indian community, engaging the local 

communities in identifying and sharing healthy traditional ways of eating, physical activity, 

communicating healthy messages and supporting efforts for diabetes prevention and 

wellness. The program emphasizes traditional foods education, growing, harvesting and 

preserving of locally grown/caught foods, engagement of community leadership to facilitate 

food behavior changes, and preserving wisdom through collection of traditional 

stories. Participation in the program is expected to increase as more tribal members learn about 

the Healthy Traditions project and what resources are available to them. The Steering 
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Committee is currently working on developing healthy policies for CTSI and suggestions to be 

included in the 2015-2025 Comprehensive Plans. Funding-$100,000.

The Native Gardens Project: An Indigenous Permaculture Approach to the Prevention and 

Treatment of Diabetes : By reclaiming cultural knowledge and traditions of companion 

gardening through their Native Gardens Project, the Standing Rock Sioux Tribe strives to 

prevent diabetes and contribute to a better quality of life for individuals and families living with 

diabetes. The Nutrition for the Elderly Program Advisory Council, the Standing Rock Special 

Diabetes Program, the state and county Extension Service, Sitting Bull College, and other 

partners support the Native Gardens’ efforts to make local foods from farms and family gardens 

available and accessible. In collaboration with the USDA Nutrition for the Elderly program, 

the program documented that 60 percent of 3000 vouchers distributed to elders generated 

$9,000 in 2010, encouraging local, certified farmers to keep growing. Through 4-H and Boys 

and Girls Clubs, youth are engaged; gathering berries and other wild edibles on hikes. Well 

advertised “Winter” and “Summer” markets consistently operate, providing opportunities to 

preserve food and share stories through the cold months of winter. Funding-$100,000.

Tohono O'odham Food, Fitness & Wellness Initiative : The Tohono O’odham Food, Fitness, and 

Wellness Initiative increases knowledge of and access to Traditional Foods, while engaging 

IOBUSD and tribal legislation in identify ways to improve school health environments. 

Through strengthened partnerships with IOUSD and Head Start, Traditional Foods were 

offered in meals and snacks at least weekly during the school year (2010-2011). Trainings and 

educational workshops were offered to teachers and cooks. Y.O.U.T.H Members continue to 

demonstrate leadership and innovative approaches to education, youth engagement, and other 

TOCA endeavors. Funding-$100,000.

Food is Good Medicine: "Food is Good Medicine" offers a model that embraces traditional 

food-ways, physical activity, and community empowerment. Implementation of projects, such 

as the Young Adult Leadership Program and “Got Acorns” Campaign, have been well received 

throughout the communities served by UIHS. Featuring the local traditional staple food, tanoak 

acorn, the "Got Acorns" Campaign was developed and launched to promote the health benefits 

of traditional foods and food ways. Young adults participating in the Leadership Program were 

empowered to explore their identity, interview elders and youth significant in their lives, and 

create digital stories that will be shared at community events, including the Youth Summer 

Camps. The digital stories capture the history that binds each generation and upholds traditional 

wisdom that protects health. A plan was proposed to continue offering this program to young 

adults twice a year for a period of three months. Funding-$100,000.

NCCDPHP/Division of Reproductive Health

WISEWOMAN: SEARHC provides services to Alaska Native/American Indian women 

representing 18 tribes in Southeast Alaska. Funding-$427,823. Southcentral Foundation (SCF) 

provides services to Alaska Native/American Indian women at the Anchorage Native Medical 

Center and the Valley Native Primary Care Clinic. SCF was recognized by the American 

Public Health Association for making WISEWOMAN screening a standard of care for all 

women 40 - 64 years old presenting for their annual exam and/or a clinical breast exam.

Funding-$581,427. 

Outcomes of Screening AI/AN Women of Reproductive Age for Chronic Conditions Funding:

This project tests the efficacy of a culturally tailored Contingency Management intervention to 

promote cigarette abstinence and weight loss among American Indian and Alaska Native 
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women of reproductive age. Submitted University of Washington IRB application, received 

project approval from both of the clinical project sites; developed research tools; installing data 

mining tool at one clinical site; establishing subcontracts. Funding-$275,000.

Follow up to response to a cluster of AI fetal and infant deaths: In 2008, in response to a request 

from the Oglala Sioux tribe (OST), assistance was provided to the OST health administration to 

examine infant deaths. The tribe made an official request to CDC’s Division of Reproductive 

In response to this request, a site visit was made to conduct an assessment. In May of 2011, in 

response to an OST health administration request, Dr. Barradas returned to Pine Ridge to 

conduct a formal presentation, describing the assessment, findings, recommendations, and 

resources, before members of the OST Tribal Council. Funding-$1,000 (approximately 1% of 

one staff member for technical assistance).

Pregnancy outcomes in Alaska Native smokeless tobacco users: The primary objective of this 

study was to explore the potential effects of maternal smokeless tobacco use on pregnancy 

outcomes. The secondary objectives were to explore the effects of maternal smokeless tobacco 

use on glucose tolerance, complications of labor and delivery, maternal hospital length of stay 

and readmission, fetal growth, severity of preeclampsia and on infant complications. The study 

was based in the Yukon Kuskokwim area of Alaska. Data collection is complete. In FY 2011, 

the two persons who led the research developed two manuscripts reporting on the study 

outcomes. Funding-$34,000 for intramural staff salary/technical assistance.

South Dakota Tribal Pregnancy Risk Assessment: The Yankton Sioux Tribe (YST) and the 

Aberdeen Area Tribal Chairmen’s Health Board (AATCHB) identified maternal and child 

health as the highest health priority in response to persistently high rates of infant mortality 

among the 9 American Indian tribes in South Dakota. Between 2007 and 2010, CDC funded 

the South Dakota Tribal (SDT) PRAMS project that collected information exclusively from 

mothers of AI infants who recently gave birth to a live infant in SD, and Sioux County North 

Dakota. Although the project has formally ended, CDC continues to provide technical 

assistance to support preparation of SDT reports for individual tribes, topic-specific briefs 

requested by AATCHB, development of a manuscript describing the successful SDT 

methodology, and capacity development through mentoring the first Council of State and 

Territorial Epidemiologist AI maternal and child health fellow, who was assigned to 

AATCHB. Funding-$83,830 intramural/technical assistance.

NCCDPHP/Office on Smoking and Health

Tobacco Prevention National Networks: The American Indian/Alaska Native Network 

coordinates and evaluates tobacco control in American Indian/Alaska Native populations. The 

Network members will play an integral role in supporting and advancing the practice of 

tobacco control and prevention with the CDC, States, and local communities by linking 

communities with resources and by bringing members together to inform the larger tobacco 

movement of needs from the American Indian/Alaska Native community. Funding-$400,000.

National Center for Injury Prevention and Control (NCIPC)

NCIPC/Division of Unintentional Injury Prevention

Effective strategies to Reduce Motor Vehicle Injuries among AI/AN: This program is to 

design/tailor, implement and evaluate Native American community-based interventions with 

demonstrated effectiveness for preventing motor vehicle injuries within the following areas: 1) 

strategies to reduce alcohol-impaired driving among high risk groups; 2) strategies to increase 
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safety belt use among low use groups; and 3) strategies to increase the use of child safety seats 

among low use groups. An overriding intent of this funding is to assist tribes in developing 

evidence-based effective strategies in programs, which take into consideration the unique 

culture of Native Americans. Funding was awarded to 8 grantees: Colorado River Indian Tribe 

Funding-$101,885, Southeast Alaska Regional Health Consortium Funding-$70,000, California

Rural Indian Health Board Inc. Funding-$101,972, Sissetom-Wahpeton Oyate of the Lake 

Traverse Reservation Funding $102,000, Rosebud Sioux Tribe Funding-$90,000, Office of 

Health Services Funding-$101,486, Caddo Nation of Oklahoma Funding-$70,000 and Oglala 

Souix Tribe, Department of Public Safety Funding-$70,000.

Office of Public Health Preparedness and Response (OPHPR)

OPHPR/Public Health Emergency Preparedness

Community Preparedness: The funds will be used to support emergency preparedness planning 

activities, trainings and exercises. Funds will also be used to support cooperative planning 

efforts and engagement with the tribe's public health and public safety partners in neighboring 

communities, and with its partners in state government. Projects funded under this effort 

include: Alaska Native Tribal Health Consortium Funded-$350,000, White Mountain Apache 

Tribe $83,000, Tohono O’odham Nation $65,000, San Carlos Apache Tribe Funded $72,700,

Northern Arapaho Funded-$40,000, Eastern Shoshone Preparedness Funded-$40, 000, Eastern 

Band Of Cherokee Indians Funded-$35, 044, Northwest Portland Area Indian Health Board: 

Representing 55 tribes Funded- $456, 039, Santa Domingo Pueblo Funded- $3,000, Santa Ana 

Health Center Funded- $3,000, San Felipe Pueblo Funded- $3,000, Jemez Pueblo Funded-

$3,000, Isleta Pueblo Funded- $3,000, Cochito Pueblo Funded- $3,000, Sandia Pueblo Funded-

$3,000, Winnebago Tribal Health Funded- $30,000, Santee Health Center Funded- $30,000, 

Ponca Tribe Funded- $30,000, Omaha Tribe Funded- $30,000, White Earth Tribal Council 

Funded- $17,000, Upper Sioux Community Funded- $17,000, Red Lake Band of Ojibwe 

Funded- $17,000, Prairie Island Funded- $17,000, Mille Lacs Band Funded- $17,000, Lower 

Sioux Indian Community Funded- $17,000, Leech Lake band Funded- $17,000, Grande

Portage Reservation Funded- $17,000, Fond du Lac Band Funded- $17,000, Bois Forte 

Reservation, Tribal Council Funded- $17,000, Tribal Health Programs: Funded- $27,000, Sault 

Ste. Marie Tribe Funded- $38,126, Saginaw Chippewa Indian Community Funded-$24, 221, 

Pokagon Band of Potawatomi Funded- $21,531, Match-E-Be-Nash-She-Wish Potawatomi 

Funded- $20,000, Little Traverse Band of Odawa Indians Funded-$22,250, Lac Vieux Desert 

Band of Lake Superior Chippewa Indians Funded- $20,899.00, Little River Band Funded-$21, 

346, Keweenaw Bay Indian Community Funded-$23,232, Huron Potawatomi Funded-$20,735, 

The Wampanoag Tribe of Gay Head Funded-$3, 143, The Wampanoag Tribe (Mashpee) 

Funded-$50,741, Kickapoo Tribe Funded-$8,250, Iowa Tribe of Kansas and Nebraska 

Funded-$4,977, The Sac and Fox Nation Funded-$4,017, Prairie Band Potawatomi Tribe 

Funded-$6,300, Southern Ute Indian Tribe: Funded-$ 14,000, Ute Mountain Ute Indian Tribe: 

Funded-$14,000 and Meskwaki Tribal Health Funded-$7, 594

Office for State, Tribal, Local and Territorial Support (OSTLTS)

OSTLTS/Division of Public Health Performance Improvement

National Public Health Improvement Initiative: Funding will support increased efficiencies of 

program operations, promotion of evidence-based strategies, policies and practices, and 
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acceleration in public health accreditation readiness. The action plan outlines planned activities 

and milestones this funding will achieve. The Division of Community Health Services (DCHS) 

will increase Public Health Performance Management – Capacity Development and provide 

leadership in positioning ANTHC for national public health accreditation. Efforts will focus on 

developing an internal quality/performance improvement environment within DCHS, forming a 

multi-sector, cross-jurisdictional partnership coalition, disseminating and facilitating use of 

public health data among regional tribal health organizations and communities, and promoting 

implementation of evidence based strategies, policies and laws. Assessments will be completed 

using the National Public Health Performance Standards Program assessment tool and the Public 

Health Accreditation Board self-assessment. Strong collaboration and strategic partnerships will 

be encouraged by fostering extensive community participation with representatives from state, 

tribal and local public health entities, stakeholders, academia, businesses, private and non-profit 

health agencies and organizations, professional organizations, private care providers, 

philanthropic groups and third party payers. In addition, subject matter experts in key areas such 

as workforce development, laboratory capacity, and epidemiology, will be solicited to ensure the 

most recent information for public health practice is embodied in the assessment, analysis and 

strategic planning process.

 The Mille Lacs Band of Ojibwe (MLBO) will continue work to identify public health needs 

of the community and to react by organizing prevention activities to address those concerns. 

MLBO will advance it’s accreditation process and improve overall care of patients. Funds 

will allow access to a software system to chart patient’s data and enable on-going dialog 

between health care professionals. Funding-$250,000

 Increase efficiencies of Montana and Wyoming Tribal Health Department operations

Increase the use of evidence-based policies and practices among Montana and Wyoming

Tribal Health Department; Increase Montana and Wyoming Tribal Health Departments' 

readiness for applying for and achieving accreditation by the Public Health Accreditation 

Board – PHAB MTWYTLC/RMTEC intends to perform this by funding the top three 

Tribal Health Department capacity building priorities the Tribal Health Departments 

committed to during their most recent strategic planning sessions, tailored towards the 

activities listed above. Each of the 10 Montana and Wyoming Tribal Health Departments 

will be awarded funds to carry out those activities, hence building their capacity towards 

Public Health Accreditation readiness. Funding-$250,000.

 Through this grant, the Navajo Nation will continue to build upon and strengthen its public 

health infrastructure by implementing in year 2, key components of the Navajo Nation 

Strategic Plan developed in year 1 of the grant. In this regard, the Focus Areas for year 2 

will be; Addressing identified deficiency areas in preparation for PHAB accreditation; 

Development of a Navajo Nation wide Community Health Assessment; Developing a 

Quality Improvement Initiative addressing the effectiveness of a key NDOH service 

provided; Developing key cross-jurisdictional partnerships with at least one local health 

department in each of the 3 states (NM, AZ, Utah) where Navajo residents are located; 

Identifying and Implementing traditional healing best practices in one of the following 

areas: Behavioral Health (alcohol), HIV, and Diabetes. Funding-$250,000

 The Tribal Public Health improvement project will continue to increase the Northwest 

Portland Area Indian Health Board’s ability to provide education and technical support to 

increase the organizational capacity of its 43 member tribes. The Board will facilitate 
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access to quality improvement training and promote integration of a “QI culture” into tribal 

health departments as well as link quality improvement with public health accreditation.

Funding-$250,000

 Gila River will conduct a comprehensive review and analysis of existing programs and 

develop recommendations for improving the health care management structure. Long term 

activities across three distinct entities will be integrated under a new health authority which 

will result in increased efficiencies. Activities planned include developing organizational 

structure to increase quality and accountability; establish roadmap for an integrated 

consolidated sustainable health care system; supporting a stable well-trained workforce and 

increasing efficiencies in prevention and treatment for patients, clients and residents.

Funding-$250,000

 Cherokee Nation is currently working towards expanding and improving our current Tribal 

Public Health infrastructure in an effort to better serve our people as well as having our 

Tribal Public Health System achieves accreditation through the Public Health Accreditation 

Board. Funding- $843,662

 SEARHC will increase its capacity to improve the effectiveness of its organizations, 

practices, partnerships, program resources, and systems. Project deliverables include a 

consortium-wide emergency preparedness plan and engagement with a “Lean” management 

consulting company to improve our referral. Funding-$250,000.

3. Affordable Care Act Activities specific to Tribes

National Center for Chronic Disease Prevention and Health Promotion 

(NCCDPHP)

NCCDPHP/Division of Community Health (DACH) (Proposed)

Community Transformation Grants, Total Funding $3,824,699

 The Sault Ste. Marie Tribe of Chippewa Indians is receiving $500,000 to serve an estimated 

tribal population of over 176,000 within the state of Michigan. Work will target tobaccofree living, active living and healthy eating, quality clinical and other preventive services, 

and healthy and safe physical environments.

 The Sophie Trettevick Indian Health Center is receiving a $218,929 planning award to 

build capacity to support healthy lifestyles among an estimated tribal population of 2,200 

within the state of Washington. Work will target tobacco-free living, active living and 

healthy eating, and quality clinical and other preventive service.

 The Southeast Alaska Regional Health Consortium is receiving $499,588 to serve an 

estimated population of 72,000 within the state of Alaska. Work will focus on expanding 

efforts in tobacco-free living, active living and healthy eating, and quality clinical and other 

preventative services.

 The Toiyabe Indian Health Project is receiving a $500,000 planning award to build capacity 

to support healthy lifestyles among an estimated tribal population of 3,000 within the state 

of California. Work will target tobacco-free living, active living and healthy eating, quality 

clinical and preventive services, social and emotional wellness, and healthy and safe 

physical environments.
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 The Yukon-Kushokwin Health Corporation is receiving a $193,340 planning award to build 

capacity to support healthy lifestyles among an estimated tribal population of 25,000 within 

the state of Alaska. Work will focus on expanding efforts in tobacco-free living, active 

living and healthy eating, quality clinical and other preventive services, and healthy and 

safe physical environments.

 The Confederated Tribes of the Chehalis Reservation is receiving a $498,663 planning 

award to build capacity to support healthy lifestyles among an estimated tribal population 

of 1,500 within the state of Washington. Work will target tobacco-free living, active living 

and healthy eating, and quality clinical and other preventive services.

 The Great Lakes Inter-Tribal Council, Inc. is receiving a $499,982 planning award to build 

capacity to support healthy lifestyles among an estimated tribal population of over 8,000 

within the state of Wisconsin. Work will target tobacco-free living, active living and 

healthy eating, quality clinical and other preventive services, social and emotional wellness, 

and healthy and safe physical environments.

REACH US: Overarching Goal: Reduce the rate of infant mortality among American Indians 

on the Wind River Indian Reservation through community-based approaches that will serve as 

a model for other Tribes and communities.

 The Northern Arapaho Tribe of the Wind River Indian Reservation (WRIR) Action 

Community (AC) Infant Mortality Prevention Program (IMPP) plans to reduce the rate of 

infant mortality among American Indians on the WRIR through community-based 

approaches. Funding-$398,807. These approaches include increasing community awareness 

and commitment to eliminating infant mortality disparities through coordinated and multiorganizational action; increasing the number of Northern Arapaho and Eastern Shoshone 

women initiating early, and sustaining, prenatal care; ultimately achieving measurable 

improvements in infant mortality rates. This will be done through community organization, 

education, inter-agency coordination and partnership, systems development and 

modification, and increasing access to health services. For grant year five, an important 

aspect of the Community Action Plan (CAP) will be to convene and organize all partners to 

consider how to sustain the momentum the IMPP has created around the healthy priority 

while expanding the breadth and the depth of their programmatic efforts.

 The Cherokee Choices Program of the Eastern Band of Cherokee Indians works to change 

social norms, engage formal and informal leaders, and engage communities to reduce the 

risk for type 2 diabetes and cardiovascular disease in rural western North Carolina. 

Funding-$415,390.

 The Choctaw Nation of Oklahoma (CNO) Action Community (AC) Lifetime Legacy 

Program (LLP) plans to decrease heart attack and stroke risk in the CNO population 

through education, awareness and community based active living and healthy eating policy 

and environmental change efforts. Funding-$415,390. 

 For year five, ITCM REACH will continue to implement community-based intervention 

activities to reduce cardiovascular and diabetes related disparities that are culturally tailored 

to each of the three original tribal communities, while providing overall technical assistance 

to the tribes and disseminating results of the culturally tailored interventions among 

consortium partners. Funding-$415,390. 
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4. Tribal Delegation Meetings:

October 13-14, 2010: ATSDR and UNM hosted the Navajo Prospective Birth Cohort Study 

Kick-off meeting at the University of New Mexico (UNM) Center for Development and 

Disability in Albuquerque. Attendees included representatives from UNM, Navajo Area 

Indian Health Services (NAIHS), Navajo Nation Division of Health (NNDOH), Navajo 

Nation Environmental Protection Agency (NNEPA), Community Liaison Group, and Navajo 

Nation’s Growing in Beauty Program. The purpose of the meeting was to discuss stakeholder 

roles and responsibilities and other issues that needed to be addressed before commencing the 

study. ATSDR staff from the Division of Health Studies, Office of Tribal Affairs (OTA), and 

Region 9 were also in attendance.

October 20-22, 2010: The ATSDR Region 9 Representative attended the Annual EPA Tribal 

Conference in San Francisco, CA. The theme for the conference was “Tribal Environmental 

Programs: Past, Present, and Future” and included workshops presentation, and training 

opportunities for funded tribal programs in environmental protection and emergency response.

October 25, 2010: Tribal BRFSS Project, ONDIEH: NCCDPHP-DCPC, also 2/21/11, 

4/15/11, 5/26/11 by conference call and in person, 5/3/11 at National Cancer Control Program 

Director's Meeting in Atlanta. To brief Tribal NCCCP Program Directors on the status of the 

Tribal BRFSS Project and to gather their input on project activities. To brief Tribal NCCCP 

Program Directors on the status of the Tribal BRFSS Project and to gather their input on 

project activities.

October 27-28, 2010: The ATSDR Region 9 Representative gave a presentation on behalf of 

Ms. Schultz, HHS Region 9 Director, at the 44th Inter-Tribal Council of Nevada Annual 

Meeting in Reno, NV. The ATSDR Region 9 Representative discussed HHS tribal activities 

in Nevada and provided updates on upcoming ACA outreach activities.

December 2010: ATSDR and UNM representatives presented the Navajo Birth Cohort Study 

objectives to the Navajo Nation Human Health and Review Board (NNHHRB) and sought 

approval for elements of the study protocol. After numerous discussions with the NNHHRB 

members, a decision to approve the protocol was postponed until additional information could 

be gathered by UNM and ATSDR.

December 1, 2010: At the invitation of the EPA Tribal Science Council, the NCEH/ATSDR 

Tribal Liaison traveled to Seminole, FL to provide a presentation on NCEH and ATSDR 

environmental health activities and to discuss ways in which to collaborate. Tribal and EPA 

participants also provided presentations on various activities related to data gathering and data 

analysis.

February 4, 2011: CDC/ASTHO/NIHB held a meeting to discuss Tribal/State relations. 

Attendees of the meeting included representatives from the three agencies, CDC Tribal 

advisory Committee members and State Health Officials. The meeting was an opportunity to 

begin dialog on the issue. An outcome of the meeting was to have additional meetings on the 

subject. The next meeting will be in Atlanta, GA on February 3, 2012.

February 23, 2011: At the request of a concerned citizen, the NCEH/ATSDR Tribal Liaison 

and the ATSDR Region 6 Representative traveled to the Ponca Nation in Oklahoma to 

conduct a tour of the tribal community in order to observe nearby permitted facilities. ATSDR 

also met with Ponca Nation’s Environmental Director to discuss environmental health and 
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environmental protection concerns from the emission sources and to discuss ways in which to 

conduct an appropriate assessment of potential exposure pathways.

February 24, 2011: The NCEH/ATSDR Tribal Liaison and the ATSDR Region 6 and 7 

Representatives attend the HHS Regions 6, Tribal Consultation Session and to be on hand to 

field any questions from tribal leaders. The meeting provided an opportunity to hear about the 

public health and environmental health concerns of tribal leaders and to discuss ways in 

which tribes could collaborate with the HHS agencies.

March 3-4, 2011: The NCEH/ATSDR Tribal Liaison attended the HHS Annual Tribal Budget 

Consultation Session in Washington, DC. This was an opportunity to hear from tribal leaders 

across the country about their funding needs to address the diverse public health (PH) and 

environmental health (EH) concerns in tribal communities. HHS Secretary Sebelius also 

attended the meeting and engaged tribal leaders in discussions on how to address their PH and 

EH needs.

March 4, 2011: The NCEH/ATSDR Tribal Liaison attended a HHS Environmental Justice 

(EJ) Interagency Work Group meeting in Washington, DC. Several updates were provided 

including information about plans to develop a HHS EJ strategic plan; a presentation was 

given on tracking; and each of the HHS agency representatives discussed their respective EJ 

activities.

March 9, 2011: REACH US Technical Assistance workshop took place in Atlanta, GA. The 

purpose was to convene the REACH US and National Organizations that serve Minority 

Communities (MNOs) grantees for technical assistance, planning, evaluation and other 

programmatic issues.

March 28, 2011: Communities Putting Prevention to Work (CPPW), ONDIEH: NCCDPHPDACH, Atlanta, GA. The Annual Meeting was a training to strengthen and expand agency 

capacity to achieve program goals to reduce obesity and tobacco use, network with peers, and 

accelerate successes by building peer-to-peer consultation. Participants included: Cherokee 

Nation representatives, CDC, contractors, and technical assistance providers.

April 12, 2011: The 2nd Annual Nevada Tribal Methamphetamine Summit was held in Fallon, 

NV. 62 participants attended including tribal representatives from Nevada, California, and 

South Dakota. Also in attendance were representatives from the Indian Health Service (IHS), 

Washoe County Health District, Nevada Department of Environmental Protection and Nevada 

Health Division. ATSDR provided coordination support and faculty from American College 

of Medical Toxicology (ACMT). The event was also sponsored by the Inter Tribal Council of 

Nevada, Statewide Native American Coalition and Nevada Tribal Chiefs of Police 

Association. The training included a presentation by EPA Brownfield program on grant 

opportunities for meth lab cleanup and assessment for tribes. The agenda also included a 

panel/open discussion of issues concerning residential meth contamination which was well 

received. Participant evaluation forms were overwhelmingly positive and many indicated they 

would like additional training opportunities.

April 26, 2011: The first Annual Tribal Consultation Session for the Navajo Nation was held in 

Window Rock, AZ. The primary purpose of the consultation was to provide an opportunity 

for Navajo tribal leaders to discuss programmatic issues and overall concerns of the Navajo 

Nation with U.S. Department of Health and Human Services (HHS) officials and HHS agency 

representatives. The ATSDR Division of Health Studies Branch Chief provided an update on 

the Navajo Birth Cohort Study activities and the NCEH/ATSDR Tribal Liaison provided 
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updates on various CDC activities including plans to fill the Associate Director for Tribal 

Support position at CDC/OSTLTS and to field questions regarding CDC’s Emergency 

Preparedness and Response Program.

April 28, 2011: The NCEH/ATSDR Tribal Liaison represented CDC and ATSDR at the HHS 

Region 6 & 8 Tribal Consultation Session in Albuquerque, NM. The Tribal Liaison provided 

updates on activities related to the hiring of the OSTLTS Associate Director for Tribal 

Support, revisions to the CDC/ATSDR Tribal Consultation Policy, and a brief overview of 

the ATSDR Birth Cohort Study on the Navajo Nation.

May 2, 2011: Strategic Alliance for Health, ONDIEH: NCCDPHP-DACH, Chicago, IL. 

Strategic Alliance for Health Action Institute provided an opportunity for states and Strategic 

Alliance for Health communities to come together to learn best practices on implementing 

policy, systems, and environmental change strategies. Cherokee Nation leaders met with their 

CDC project officer to discuss the initiative and other projects. In addition, a Cherokee 

Nation representative presented Cherokee Nation Strategic Alliance for Health Tobacco-Free 

Policy for City Parks Implementation Guide to the Action Institute participants. Six 

participants came to the Action Institute. The intervention area includes the Tribal 

Jurisdictional Service Area (TJSA) of 9,200 sq. miles with a population of 399,385 in 14 

counties. The Cherokee Nation has developed, implemented, and expanded a comprehensive 

plan to implement promising strategies for healthy eating, active living, and tobacco-free 

environments in the Cherokee Nation of Oklahoma -- the Eastern band of the Cherokee 

Nation. Their interventions are guided by the research, collaboration, and recommendations 

of the public health experts and stakeholders via the Healthy Eating Active Living 

Convergence Partnership. 

June 1, 2011: CDC/IHS American Indian and Alaska Native Health Analyses Collaborations: 

OID: NCEZID-DHCPP. Meeting held with a Navajo Tribal Veterinarian. Ongoing 

epidemiologic collaborative projects with the Indian Health Service (IHS), Alaska Native 

Tribal Health Consortium (ANTHC), CDC Arctic Investigations Program (AIP), other 

agencies/divisions and universities to detect and describe disease burden and health disparities 

for overall and specific infectious diseases among American Indian and Alaska Native 

(AI/AN) communities. Studies provide information for developing prevention strategies, 

vaccination policies, and reducing health disparities related to infectious diseases. Findings 

increase awareness of specific infectious diseases, and highlight disease, person and 

geographic target areas to further investigate health disparities. For example, the identification 

of lower respiratory tract infections disparities among Alaska Native children led to more indepth respiratory studies and educational efforts for children in Alaska. 

July 19th, 2011: ATSDR Region 9 was invited to attend and participate in an EPA hosted 

meeting entitled, “Nevada Tribal Leaders Meeting for Environmental Health” in Reno, NV. 

The purpose of the meeting was to gain a better understanding of the environmental, energy, 

health priorities, and challenges for both tribes and federal agencies; identify opportunities for 

collaboration where resources and information can be leveraged; and build stronger federal 

and tribal relationships. The following federal agencies participated including EPA Region 9 

Regional Administrator and EPA program staff, Department of Energy (DOE), USDA Rural 

Development Community Programs, Bureau of Reclamation, IHS Deputy Director, IHS 

Phoenix Area Office and IHS Sparks Office, Housing & Urban Development (HUD) 

Regional Administrator and Administrator of the Southwest Office of Native American 
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Programs, and ATSDR Regional Office. Tribal Leaders from 10 NV Tribes and the InterTribal Council of Nevada leadership also participated. Participants were all engaged in the 

process.

June 10, 2011: SIP 10-033: Innovative Approaches to Preventing Teen Pregnancy among 

Underserved Populations, ONDIEH: NCCDPHP-DACH, Peach Springs, AZ, also 7/25/11 at 

Whiteriver, AZ and 8/2/2011 at Camp Verde, AZ, Hualapai Tribe. To get approval to 

implement the project with the Tribe. Approval to implement both phases of the project was 

obtained. Meeting participants included ITCA staff, and Hualapai Tribal Council.

July 26-27, 2011: The NCEH/ATSDR Office of Tribal Affairs kicked off the first meeting of 

the National Tribal Environmental Health (NTEH) Think Tank in Washington, DC. The 

agenda for the first meeting was to convey the purpose of the Think Tank and the roles and 

expectations of the members; provide an overview of OTA and NCEH and ATSDR; analyze 

and discuss the OTA purpose, mission, and vision; revise mission and vision statements as 

necessary. At the end of the meeting the Think Tank members were asked to reach out to their 

respective tribal colleagues and develop list of 5-8 issues of major environmental public 

health concern to tribes.

August 14-15, 2011: At the invitation of the Association of Environmental Health Academic 

Programs (AEHAP), the NCEH/ATSDR Tribal Liaison was asked to participate in 

discussions to work towards the development of a joint strategy for linking students from 

Tribal Colleges and Universities (TCUs) with National Environmental Health Science and 

Protection Accreditation Council (EHAC) programs. The goal of the joint strategy would be 

increase the number of American Indians/Alaska Natives (AI/AN) entering the environmental 

health workforce. Participants included TCU representatives and students, representatives 

from adjacent colleges and universities, CDC, and AEHAP members. Discussions continue to 

occur between all parties.

August 16, 2011: ATSDR Division of Regional Operations (DRO) coordinated with the 

Pechanga Band of Luiseño Indians Environmental Department to host a training course 

entitled “Environmental and Health Consequences of Clandestine Methamphetamine 

Laboratories” in Temecula, CA. 120 participants representing tribal, county, state and federal 

agencies were in attendance for this event. Chairman Mark Macarro and Council Member 

Andrew Masiel, Sr., both with the Pechanga tribe, gave opening remarks and a welcome 

address. Feedback about the course was positive.

August 25, 2011: A second meeting of the National Tribal Environmental Health (NTEH) 

Think Tank took place in Suquamish, WA following the CDC/ATSDR Tribal Advisory 

Committee (TAC) meeting and tribal consultation session on August 22-24, 2011. The agenda 

for the second meeting included the discussion and prioritization of major environmental 

health concerns/issues as compiled by NTEH Think Tank members; the development of clear 

goals statements based on top ten broad issue areas; and a brainstorming session on long- and 

short-term strategies and tactics which can be undertaken by OTA to address priority issues.

September 14, 2011: Outcomes of Screening AI/AN Women of Reproductive Age for Chronic 

Conditions, ONDIEH: NCCDPHP-DRH, South Dakota. The project was reviewed by the 

Ogala Sioux Tribe Research Review Board and the project was approved. On 9-29-2011 we 
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held a conference call for the initial kick-off of the project. On this call was Lisa SchraderDillon, Health Administrator and other representatives from the Tribal Health Department. 

September 24-25, 2011: The third meeting of the National Tribal Environmental Health Think 

Tank took place in Anchorage, AK. The agenda for the third meeting included activities to 

discuss and finalize specific approaches OTA must take to accomplish the outlined goals; 

discuss implementation of the OTA strategic plan, including any potential barriers and/or 

challenges; and compile a draft the OTA Strategic Plan based on deliberations. At the end of 

the third meeting, the members requested that the Think Tank effort continue in future years. 

They felt strongly that in order to support the efforts of tribes, a continual mechanism needed 

to be established. The OTA hopes to continue the effort in future years.

September 26 to 28, 2011: Communities Putting Prevention to Work (CPPW), ONDIEH: 

NCCDPHP-DACH, Orlando, FL. Healthy Communities Meeting increased knowledge of 

strategies and resources to assist in development and implementation of policy, systems and 

environmental changes that increase access to healthy foods and physical activity, and reduce 

secondhand smoke exposure. 

September 27, 2011: NCEH/ATSDR staff and members of the National Tribal Environmental 

Health (NTEH) Think Tank gave a presentation of their efforts to develop and implement an 

NCEH/ATSDR OTA Strategic Plan at the National Indian Health Board’s (NIHB) Annual 

Consumer Conference (ACC) in Anchorage, AK. Feedback was sought from the audience 

regarding their environmental health concerns and priorities.

5. Agency Tribal Technical Advisory Group

CDC/ATSDR held two formal Tribal Advisory Committee (TAC) meetings during FY 2011 

along with regularly scheduled conference calls. The TAC meeting was held February 1 and 

2, 2011 in Atlanta GA and August 22 and 23, 2011 in Suquamish, Washington. The 

OD/Office for State, Tribal, Local and Territorial Support (OSTLTS)/Senior Tribal Liaisons 

worked in collaboration with the TAC co-chairs and membership to develop substantive 

agendas. TAC members provide an area report to inform and discuss public health issues 

affecting their tribe and other tribes in their area, and CDC provides a progress report on

actions taken in response to TAC recommendations. The meetings focused on resource 

allocations and budget priorities, public health preparedness and emergency response, 

epidemiology and disease surveillance, and environmental public health in Indian Country.

This past year the focuses of the Tribal Consultation Sessions were CDC’s Winnable Battles. 

Discussions regarding Smoking, Physical Activity, Obesity and Nutrition, Teen Pregnancy, 

HIV/AIDS, Hospital Associated infections and Motor Vehicle Safety were very lively. The 

exchange of information was very useful. CDC leadership listened to powerful tribal 

testimonies reflecting critical health needs present in many AI/AN communities and 

responded to specific questions asked by tribal leaders. These Consultation Sessions are 

helping CDC understand the scope and difficult realities tribal nations are facing. 

Consultations have provided opportunities for meaningful dialogue between tribal leadership 

and CDC leadership resulting in new initiatives, programs, and collaborations to address 
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public health needs while maintaining CDC’s commitment to uphold the tenets of tribal 

consultation and to have a positive impact on the health of AI/AN people.

6. Agency Tribal Consultation Policy

CDC/ATSDR Tribal Consultation Policy, General Administration CDC-115 was issued on 

October 18, 2005. The document establishes the CDC and ATSDR policy on consultation 

with American Indian and Alaska Native governments and tribal leaders and provides 

guidance for working effectively with IA/AN communities and organizations and enhancing 

IA/AN access to CDC programs. As an OPDIV within HHS, CDC’s policy on tribal 

consultations will adhere to all provisions in the HHS Tribal Consultation policy revised 

December, 2010.

CDC/ATSDR is currently working on revising the policy. It is anticipated that the policy will 

be signed by summer 2012. OSTLTS’s Tribal Support Unit has the lead in coordinating the 

revisions. 

CDC will honor the sovereignty of American Indian/Alaska Native governments, respect the inherent 

rights of self-governance, commit to work on a government-to-government basis, and uphold the 

federal trust responsibility. Government-to-government consultation will be conducted with elected 

tribal officials or their designated representatives. The CDC will also confer with tribal and Alaska 

Native organizations and AI/AN urban and rural community before taking actions and/or making 

decisions that affect them. Consultation will include affected AI/AN governments and appropriate 

AI/AN organizations. 

Although the federal-tribal government-to-government relationship encompasses federally recognized 

tribes, other statutes and policies exist that allow for consultation with non-federally recognized tribes 

and other AI/AN organizations that, by the nature of their business, serve AI/ AN people and might be 

negatively affected if excluded from the consultation process. In cases where the government-togovernment relationship does not exist, as with programs in urban areas established to serve AI/ANs, 

state-recognized tribal groups, and other AI/AN organizations, HHS policy dictates that consultation 

take place to the extent that there is not a conflict-of-interest in stated federal statutes or authorizing 

language. However, if CDC wants to include organizations that do not represent a specific federally 

recognized tribal government on advisory committees or work groups, then Federal Advisory 

Committee Act (FACA) requirements must be followed. 

This tribal consultation policy does not waive any tribal governmental rights, including treaty rights, 

sovereign immunities or jurisdiction; and nothing in the policy creates a right of action against CDC or 

HHS for failure to comply with the policy. Nothing in this policy waives the government’s 

deliberative process privilege.
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Acronym List

AAIHS Albuquerque Area Indian Health Service

AATCHB Aberdeen Area Tribal Chairmen’s Health Board

AC Action Community

ACMT American College of Medical Toxicology 

AI/AN American Indian/Alaska Native

AIDS Acquired Immunodeficiency Syndrome

AIP Arctic Investigations Program

ANTHC Alaska Native Tribal Health Consortium

ANTHC Alaska Native Tribal Health Consortium 

APHA American Public Health Association

ASTHO Association of State and Territorial Health Officers

ATSDR Agency for Toxic Substances and Disease Registries

AZDHS Arizona Department of Health Services

BIE Bureau of Indian Education

CAB Capacity Building Assistance

CAP Community Action Plan

CBO Community-Based Organization

CCPP Catawba Cultural Preservation Project

CDC Centers for Disease Control and Prevention

CHS Coordinated School Health

CNO Choctaw Nation of Oklahoma

CPG Community Planning Group

CPPW Communities Putting People to Work

CRCCP Colorectal Cancer Control Program

CRCS Comprehensive Risk Counseling and Services

CSPS Comprehensive STD Prevention Services

CTR Counseling, Testing and Referral

CTSI Confederated Tribes of Siletz Indians

DASH Division of Adolescent and School Health

DETS Diabetes Education in Tribal Schools

DOE Department of Energy 

DOEH Department of Occupational and Environmental Health

DOH Department of Health

DSNS Division of Strategic National Stockpile 

DVBD Division of Vector Born Diseases

EBI Evidence-based Behavioral Intervention

EH Environmental Health

EIS Epidemiologic Intelligence Officer

EJ Environmental Justice 

EMS Emergency Medical Services

EPA Environmental Protection Agency

ERNEH Empowering Ramah Navajos to Eat Healthy

FACA Federal Advisory Committee Acct
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FDL Fond du Lac

GYT Get Yourself Talking

HD Health Departments

HHS Department of Health and Human Services 

HIV Human Immunodeficiency Virus 

HRAC Health Research Advisory Council

HTAC Health Traditions Advisory Council

HUD Housing & Urban Development 

IAA Inter Agency Agreement 

IH Industrial Hygiene

IHS Indian Health Service 

IMMP Infant Mortality Prevention Program

IOBUSD Indian-Oasis Baboquivari Unified School District 

IPA Intergovernmental Personnel Agreement 

IPP Infertility Prevention Projects

ITU Indian, Tribal and Urban

LCMV Lymphocytic choriomeningitis virus

LLP Lifetime Legacy Plan

MAPPS Media, Access, Pint of Purchase/Promotion, Price and Social Support Svc

MCH Maternal and child health 

MDHFS Minneapolis Department of Health & Family Support

N/A Not Applicable

NACCHO National Association of City and County Health Officials

NACCHO National Association of City and County Health Officials

NACR Native American Cancer Research Corporation

NAIHS Navajo Area Indian Health Service

NBCCEDP National Breast and Cervical Cancer Early Detection Program 

NCBDDD National Center on Birth Defects and Developmental Disabilities 

NCCCP National Comprehensive Cancer Control Program 

NCCDPHP National Center for Chronic Disease Prevention and Health Promotion 

NCEH National Center for Environmental Health 

NCEZID National Center for Emerging and Zoonotic Infectious Diseases 

NCHHSTP National Center for HIV, Hepatitis, STD and Tuberculosis Prevention 

NCHS National Center for Health Statistics 

NCIPC National Center for Injury Prevention and Control 

NCIRD National Center for Immunization and Respiratory Diseases 

NCRCCP National Colorectal Cancer Control Program 

NDEP National Diabetes Education Program 

NDI National Death Index

NDOH Navajo Division of Health

NDWP Native Diabetes Wellness Program 

NHANES National Health and Nutrition Examination Survey 

NIHB National Indian Health Board 

NIOSH National Institute for Occupational Safety and Health 

NMDOH New Mexico Department of Health
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NNEPA Navajo Nation Environmental Protection Agency 

NNHHRB Navajo Nation Human Health and Review Board 

NPCCCP Northern Plains Comprehensive Cancer Control Program

NPCR The National Program of Cancer Registries 

NPHII National Public Health Infrastructure Initiative

NPHPSP National Public Health Performance Standards Program 

NPIRS National Patient Information and Reporting System

NTEC Northwest Tribal Epidemiology Center 

NTEH National Tribal Environmental Health Think Tank

NTTPN National Tribal Tobacco Prevention Network 

OID Office of infectious Diseases

OMHD Office of Minority Health and Health Disparities 

ONDIEH Office of Non-communicable Diseases, Injury and Environmental Health

OPDIV Operating Divisions (of HHS)

OSH Occupational Safety and Health

OST Oglala Sioux Tribe

OSTLTS Office for State, Tribal, Local and Territorial Support

OTA Office of Tribal Affairs

PCV Pneumococcal Conjugate Vaccine 

PCV Pneumococcal conjugate vaccine 

PGO Program and Grants Office 

PH Public Health

PHHS Preventive Health and Health Services

PHLP Public Health Law Program

PHPS Public Health Prevention Services

PPMNS Planned Parenthood of Minnesota, North Dakota and South Dakota

PRAMS Pregnancy Risk Assessment Monitoring System

QTEM Quarterly Tribal Epidemiology Meeting

REACH US Racial and Ethnic Approaches to Community Health

RMSP Rocky Mountain Spotted Fever

RTHP Return to a Healthy Past

SAH Strategic Alliance for Health

SCF Southcentral Foundation 

SEARHC Southeast Alaska Regional Health Consortium

SEARHC Southeast Alaska Regional Health Consortium

SEER Surveillance, Epidemiology, and End Results

SEIOB Surveillance, Epidemiology, and Outbreak Investigations Branch

SEM Socio-Ecological Model

SIP Special Interest Project

SKC Salish Kootenia College

SOH Seeds of Hope

SPIEC Southern Plains Inter Tribal Epicenter

SSM Sault Ste Marie Tribe of Chippewa Indians

STAFFDIV Staff Divisions

STAND Students Against Negative Decisions
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STD Sexually Transmitted Infection

STD Sexually Transmitted Disease

SWAT Students Working Against Tobacco

TAC Tribal Advisory Committee

TB Tuberculosis

TCP Tribal Consultation Policy

TCU Tribal Colleges and Universities

TEC Tribal Epidemiology Centers

TECC Tribal Epi Center Consortium

TJSA Tribal Jurisdictional Service Area 

TON Tohono O’odham Nation

UNM University of New Mexico 

USDA US Department of Agriculture

WISEWOMAN Well-Integrated Screening/Evaluation for Women across the Nation

WRIR Wind River Indian Reservation

YRBS Youth Risk Behavior Survey

YST Yankton Sioux Tribe